BACKGROUND Gangrene refers to the dead or dying body tissue (s) that occurs because the local blood supply to the tissue is either lost or is inadequate to keep the tissue alive. Foot gangrene is becoming a major concern which changes the quality of life, and also the social and economic point of view. We wanted to study the clinical profile of foot gangrene, determine the most common aetiology, distribution of age and sex, presentation, associated risk factors, commonest organisms involved, ways to find and manage the complications, and study the outcomes of foot gangrene in a rural medical college. METHODS Clinical profiles of all 50 patients with foot gangrene were studied as a prospective observational study in a rural medical college from October 2018 to October 2020. All cases were evaluated by history, clinical examination, investigations, management and follow up. RESULTS Our study involved 50 patients; youngest patient was 33 years and oldest was 70 years. Majority of patients with foot gangrene were in the age group of 41 - 50 years, (22 cases) and highest number were males, (37 cases). Diabetes mellitus is the commonest aetiology accounting for 30 cases and commonest risk factor that confounds the disease process is smoking (17 cases). The commonest presentation was blackish discoloration of toe (s) along with cellulitis and ulceration (30 cases). The commonest organism isolated from culture is methicillin resistant Staphylococcal aureus (MRSA) (13 cases). Majority of the patients underwent Ray’s amputation (16 cases) in our study and majority had no post-operative wound complication (28 cases) within the minimum follow up period of 6 months. CONCLUSIONS We have therefore attempted in our study, to analyse the gangrene of the foot since diabetic cases and trauma cases are more in the rural setup and treatment of these gangrene cases is a challenging task as well. KEY WORDS Foot Gangrene, Amputation, Diabetes Mellitus

Chronic pain is one of the leading causes of years lost to disability, as most of the time it is refractory to conventional treatment. Recent advances in understanding the pain mechanisms have favored the use of ketamine as a rescue agent in refractory chronic pain conditions, as it has potential modulating effect on both sensory-discriminative and affective motivational components of pain. Preclinical studies also suggested the antinociceptive effect of sub anesthetic dose of ketamine against central and peripheral neuropathic pain conditions and non-neuropathic pain conditions such as inflammatory and nociceptive pain states. Subanesthetic infusion of ketamine along with adjuvants such as midazolam and clonidine is found to reduce the psychomimetic and cardiovascular side effects of ketamine. Even though the consensus guidelines for intravenous use of ketamine for chronic pain advocate the use of ketamine only for complex regional pain syndrome, various other clinical studies suggested its role in other refractory painful conditions. Hence the present topic focuses specifically on the effect of ketamine on non-neuropathic pain conditions such as complex regional pain syndrome, fibromyalgia, headache, ischemic limb pain, etc. Many studies had shown that ketamine not only reduces the pain scores but also the analgesic medications, which further improves the well-being and quality of life.